Individual
BRIAN L SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2550 LUSK DR, NEOSHO, MO 64850
(417) 451-2060
(417) 451-6214
Mailing address
2550 LUSK DR, NEOSHO, MO 64850-8855
(417) 451-2060
(417) 451-6214
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2001008549
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
245312202
—
MO
Enumeration date
05/10/2006
Last updated
06/11/2018
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